Provider Demographics
NPI:1598337743
Name:STORK, MELISSA KIMBERLY (CD)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:KIMBERLY
Last Name:STORK
Suffix:
Gender:F
Credentials:CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17912 65TH DR NW
Mailing Address - Street 2:
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292-8972
Mailing Address - Country:US
Mailing Address - Phone:425-350-0770
Mailing Address - Fax:
Practice Address - Street 1:17912 65TH DR NW
Practice Address - Street 2:
Practice Address - City:STANWOOD
Practice Address - State:WA
Practice Address - Zip Code:98292-8972
Practice Address - Country:US
Practice Address - Phone:425-350-0770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0011B374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula